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BPH > How is BPH diagnosed?

The spectrum of symptoms that are associated with BPH are known collectively as lower urinary tract symptoms (LUTS for short), and are outlined in the table below.

Lower urinary tract symptoms associated with BPH

Hesitancy (when the urine flow stops and starts) A weak urine stream You need to strain to pass urine Urination takes a long time After urinating, there is still the feeling that some urine is 'left behind' in the bladder When you get the urge to urinate, you feel you need to do so urgently Frequent trips to the toilet Getting up in the night to urinate When you get the urge to urinate, you leak a little urine A sudden or slowly building inability to urinate

The symptoms of BPH overlap with those of other conditions, so your initial examination should be thorough and your doctor will question you about your general health and symptoms.   In order to assess your symptoms systematically, you may be asked questions that relate to a scoring system.   Your doctor will also be concerned with how ‘bothersome’ you find your symptoms.   Again, this can be approached in a systematic manner, and your responses can be scored.   Enquiries will be made about other conditions, such as diabetes and hypertension, and what medications you are taking.

Physical examination and digital rectal examination

A digital rectal examination will be performed to give the doctor an idea of the size and consistency of your prostate.   He will also feel your abdomen to check whether your bladder is distended so that it can be felt (if it can, this is a sign that you may be retaining urine).   Your doctor may also make an assessment of your nervous system, such as testing the muscle tone and sensation in the area around and between the scrotum and anus, as some disorders of the nervous system, such as Parkinson's disease, can give rise to urinary symptoms similar to those of BPH.   Since high blood pressure (hypertension) is common, blood pressure may also be measured as part of a general health check.

Urine test

As a urinary tract infection can cause symptoms such as an increased need to urinate, a urine sample will be checked for signs of bacterial infection or blood.   The urine may also be tested routinely for the presence of sugar, which is a sign of diabetes.

Blood tests

A very small proportion of men have kidney problems as a consequence of their BPH.   By assessing the amount of a substance called creatinine in the blood, your doctor will be able to check whether your kidneys are affected.   Your blood sugar level may also be tested to check that you do not have diabetes, as this can be a cause of frequent urination.

The amount of PSA may also be measured.   You might already have read about this in the sections on prostate cancer.   PSA is a marker that indicates damage to the prostate, often arising as a result of prostate cancer, but sometimes as a result of BPH.   In fact, the larger your prostate, the higher your PSA tends to be.   If your PSA level is raised, it may be recommended that you have a prostate biopsy so that prostate cancer can be excluded.   Your PSA level also gives a rough indication of your prostate size, and this can influence the risk of you developing urinary retention and provide information about the likely success of various medical treatment options.

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Urine flow tests (or uroflowometry)

By measuring the speed of your urine output over time, your urologist can get some useful information about your urine flow.   For this test you will have to urinate into the bowl of a specialized piece of medical equipment known as a flow meter.

A flow meter is used to record information about urine flow

The urine flow rate in men with BPH is slower than normal and lasts longer.

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Ultrasound to measure urine left in the bladder

Ultrasound can give your doctor an idea of how severe the obstruction is and how well you might respond to certain types of treatment.   The procedure is very similar to that used for pregnant women.   High-frequency sound waves are emitted from a probe that is passed over your abdomen, and the echoes build up a picture that can be seen on a computer monitor.

An ultrasound image of the bladder showing that a large volume of urine remains in the bladder after the patient has urinated.   In this example, the prostate can be seen bulging into the base of the bladder (arrowed).

Less common tests

Depending on the results of the tests already described above, your urologist may want to perform some further tests:

Urodynamic measurements are made using a small catheter that is inserted up through the urethra, via your penis, into the bladder.   By measuring the pressure within your bladder, your urologist can deduce whether your symptoms are due to obstruction from BPH or are the result of the bladder itself not working properly.   This test is uncomfortable rather than painful, and takes around 20 minutes.

Transrectal ultrasonography (TRUS) TRUS is used to visualize the prostate, measure its proportions and help guide a biopsy needle when there is a possibility of prostate cancer.

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